Microvascular changes in the retina could be an early warning sign for disability in older people, researchers reported.

Action Points

Explain that microvascular changes in the retina could be an early warning sign for disability in older people.

Note that on the other hand, there was no association for any individual sign.

Microvascular changes in the retina could be an early warning sign for disability in older people, researchers reported.

In a prospectively followed cohort, people with two or more retinal signs were 45% more likely to develop an inability to perform activities of daily living, according to Dae Hyun Kim, MD, of Beth Israel Deaconess Medical Center in Boston, and colleagues.

On the other hand, there was no association for any individual sign, Kim and colleagues reported online in Archives of Ophthalmology.

Vascular disease, including lesions in both small and large vessels, is "associated with functional impairment in older adults," the authors noted.

They had recently shown, in a cross-sectional analysis, that a higher burden of retinal signs was linked to worse executive and physical functioning.

Those findings suggested that, "retinal signs might predict future disability in performing activities of daily living," which is associated with loss of independence, institutionalization, and mortality in older adults, Kim and colleagues wrote.

To clarify the issue, they turned to the Cardiovascular Health Study, a population-based cohort study of cardiovascular disease in nearly 6,000 community-dwelling older adults that started in 1989.

Of those, 1,998 had retinal photography during the 1997 to 1998 study visit, with measurement of retinal arteriolar and venular caliber, retinopathy, arteriovenous nicking, and focal arteriolar narrowing.

After excluding those who had disability at the time of the 1998 to 1999 visit and those with missing information of some potential confounders, the researchers were left with 1,487 participants for the analysis.

Kim and colleagues found:

The prevalence of retinopathy, arteriovenous nicking, and focal arteriolar narrowing was 7.1%, 7.5%, and 10.4%, respectively

6.9% of participants with complete retinal data had two or more retinal signs

Those with two or more signs were significantly more likely to be current smokers (P=0.01) and to have higher systolic blood pressure (P<0.001)

Over a median follow-up of 3.1 years, 10.1% of those with two or more signs developed difficulty in performing activities of daily living, compared with 7.1% of those with fewer than two signs

No individual sign and no specific combinations of signs were associated with a significantly increased risk of disability.

A post-hoc analysis showed that, compared with no signs, having two or more retinal signs was associated with disability but having one sign was not.

The study "supports the hypothesis that microvascular disease accelerates age-related disability and retinal signs can be useful in understanding mechanisms and predicting outcomes," Kim and colleagues concluded.

They cautioned that the findings might be subject to selection bias, because participants in the overall study who did not have retinal photography tended to be older, female, and black, and to have more vascular risk factors and diseases.

They added that residual confounding by unmeasured factors can't be ruled out.

The study had support from the John A. Hartford Foundation, the National Institute on Aging, the Harvard Claude D. Pepper Older Americans Independence Center, the University of Pittsburgh Claude D. Pepper Older Americans Independence Center, the National Heart, Lung, and Blood Institute, a Research to Prevent Blindness Senior Scientific Award, and the National Institute of Neurological Disorders and Stroke. The journal said the authors made no financial disclosures.

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